Generational shift threatens global progress against HIV

by Anick Supplice Dupuy
Monday, 13 April 2015 20:41 GMT

A Haitian takes an HIV test at a hospital in Port-au-Prince on World AIDS Day in Port-au-Prince in this file photo. REUTERS/Eduardo Munoz

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

In confronting a resurgent HIV/AIDS epidemic, Haiti must teach a new generation about the past

Haiti has frequently been cited as one of the bright spots in the world’s battle against HIV/AIDS. The country, the poorest in the western hemisphere, saw its rate of new HIV infections plummet by more than 50 percent from 2004 to 2012. AIDS-related deaths have also dropped significantly, while more and more Haitians with HIV are now able to access life-saving anti-retroviral drug therapy.

But Haiti faces a new challenge in its drive to stamp out HIV: young people who are becoming increasingly blasé about the virus even as they become more sexually active, sometimes trading sexual favors for everyday items like a moto-taxi ride, cell phone minutes or even for school uniforms.

The lack of concern among younger Haitians about HIV is mirrored in other parts of the world. In the United States, there was a 22 percent increase in new HIV infections among gay and bisexual youths between 2008 and 2010. In Uganda, health officials have warned that new infections among young people are contributing to a jump in the national HIV prevalence rate, which has climbed back to 7.2 percent from a low of 6.4 percent in 2006.

Like their peers around the world, young urban Haitians have become far more sexually active over recent decades as traditional cultural attitudes have changed under the influence of modern media and pop culture. A third of Haiti’s population is between 10 and 24 years old and a lot of them start having sex as young adolescents. According to the recent health survey EMMUS V, more than a quarter of women and seven out of 10 men between the ages of 15 and 24 said they had their first sexual encounter before the age of 15.

SEX AS A COMMODITY

If we want to reverse these frightening numbers, we must understand how young people are forming their attitudes to sex and relationships. I went to meet some young people living in the area’s biggest slum called Jalousie’. In this slum, perched on the hill above Pétion-Ville’s main business district, I met Reynold, a 21 year-old moto taxi driver. He left school before he was 10 and because his mother can’t provide much financial support, he has been fending for himself ever since.

Reynold started having sex at the age of 13, and now has sex with multiple partners every day. Girls who don’t have cash will offer him sex in payment for a ride on his moto taxi. Reynold uses free generic condoms when he finds them, otherwise he doesn’t use any protection.

When asked if he’s concerned about HIV, he explains, “The girls are pretty and smell good, what could be wrong with them?” Reynold dreams of making enough money to apply for a US visa and only then will he take an HIV test as it is a requirement to be considered for entry into what he sees as the “Promised Land.”

Sara is a pretty 16 year old, wearing lipstick with her school uniform and extensions in her hair. For her, being considered pretty and sexy are the tools she intends to use to fight for a better life. She also has a lot of dreams, including owning a small business selling beauty products when she’s older. In the meantime, she uses sex with older men to get money to buy schoolbooks and clothes, and to go to the hair salon. For Sara, sex is a tool. She doesn’t consider herself a sex worker, and doesn’t use condoms regularly. Sara says she prays every day that she will not get HIV and will soon be able to stop depending on men.

Reynold’s and Sara’s attitudes and lack of knowledge about sexual and reproductive health are disturbing developments in a country that has been at the forefront of HIV/AIDS prevention. Our strides in reducing HIV infections over the last decade have been possible thanks to a broad approach targeting education, prevention, blood safety, voluntary counseling and testing, as well as care and treatment efforts. But this success could unravel unless we ensure that accurate information gets through to this new urban generation.

This is of crucial concern to me as both a public health specialist and as a mother. All parents should be concerned.

FUNDING DWINDLES

Funding for HIV education programs in Haiti has started to decrease as international donors shift their focus to “treatment as prevention.” This approach aims to make antiretroviral drugs available to everyone infected with HIV to reduce viral load down and decrease the likelihood a sexual partner could become infected.

Making HIV drugs available to all who need them would be a major milestone, but who will educate young people like Reynold and Sara about the risks of their behavior? Who will talk to them about the importance of using a condom to protect themselves against other sexually transmitted infections?

In addition to boosting funding for education, it’s important that those working on HIV education keep in mind a key target population: parents.

As with many traditional societies, it’s very rare for Haitian parents to talk to their children about adolescence, puberty and sexual health. It is considered taboo and believed to encourage young people to start having sex. Haitian parents have seldom been engaged in NGO work around youth sexual and reproductive health and the prevention of HIV/AIDS. I think it’s time we address this and encourage and help parents, particularly mothers, to discuss the issues that are affecting their children’s lives.

In order to overcome these obstacles we need to include parents in the discussion. Some initiatives in the US in school programs have shown that getting parents involved do in fact make a difference. Once parents are empowered they become a real force change and become leaders to advocate for and to protect their children

Young people represent the future of my country and are entitled to a childhood where they get to play and learn and have a healthy and safe life. If we can increase educational programs and persuade parents—in Haiti and around the world—to offer guidance and help to minimize risky behaviors then young people may stop seeing sex as a commodity and take better care of their health and their future.

Anick Supplice Dupuy (@asdupuy) is the Executive Director of PSI/Haiti, an NGO that focuses on promoting HIV/AIDS prevention, malaria, family planning and maternal and child health through social marketing and communication programs. She is an Aspen Institute New Voices Fellow (@AspenNewVoices).